Understanding

hypomania and mania

understanding

hypomania
and
mania
Understanding hypomania and mania

This booklet describes the symptoms of hypomania

and mania, including possible causes, treatment
and support. It includes tips for helping yourself,
plus advice for friends and family.
Contents

What are hypomania and mania? 4

What causes hypomania and mania? 8

What treatments can help? 10

How can I help myself? 13

How can friends and family help? 19

Useful contacts 22

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Understanding hypomania and mania

What are hypomania and mania?

Hypomania and mania are periods of over-active and excited behaviour
that have a significant impact on your day-to-day life.

••Hypomania is a milder version of mania that lasts for a short period (a

few days)
••Mania is a more severe form that lasts for a longer period (a week or
more).

They can be experienced as part of a mood disorder – such as bipolar

disorder, seasonal affective disorder, postpartum psychosis or
schizoaffective disorder – or as a diagnosis on their own.

Some people find hypomania and mania enjoyable, whereas for other
people it is a very uncomfortable, distressing and unpleasant experience.

I love being hypomanic because I feel as though I’m on top of

the world and can and will do anything I want, but I hate it because
I feel so disconnected from everyone else.

Everything is extremely bright and loud and everything inside

my head is moving extremely fast. I’m irritated with everyone
because no-one talks or does things as fast as I do. It’s amazing
but horrible at the same time... it’s like I’m in my own amazing
colourful world but everyone else is still stuck in the normal dull
grey one.

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 What are hypomania and mania?

Hypomania
Hypomania lasts for a few days, and is less severe than mania. It can still
have a disruptive effect on your life and people may notice a change in
your mood and behaviour. But you will usually be able to continue with
your daily activities without these being too badly affected.

Symptoms of hypomania can include:

How you might feel How you might behave

••happy, euphoric, with a ••more active than usual

sense of wellbeing
••lots of energy
••sociable
••racing thoughts
••creative and full of ideas and
plans
••like you can perform tasks
better and more quickly than
normal
••impatient, irritable or angry
••confident, with high self-
esteem
••attractive, flirtatious and/or
with more sexual desire
••restless, on edge and having
difficulty relaxing
••heightened senses – colours
may seem brighter, sounds
louder and things more
beautiful
••taking risks
••very friendly
••very talkative or writing a lot
••sleeping very little
••signing up for and taking part
in lots of activities
••taking on extra responsibilities
••wearing colourful and/or
extravagant clothes
••making lots of jokes and puns
••finding it hard to stay still -
moving around a lot or
fidgeting

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Understanding hypomania and mania

Mania
Mania lasts for a week or more and has a severe negative impact on your
ability to do your usual day-to-day activities – often disrupting or stopping
these completely. Severe mania is very serious, and often needs to be
treated in hospital.

Symptoms of mania can include any of the symptoms of hypomania listed

above, and can also include:

How you might feel How you might behave

••uncontrollably excited, like ••talking a lot and very quickly

you can't get your words out
fast enough
••racing and jumbled thoughts
••like you are special and
understand things other
people can't
••believing you are invincible
or have special powers
••very easily distracted and
unable to concentrate
••loss of insight – not
understanding that your
behaviour is unusual or that
it could cause problems
••delusions and paranoia –
thoughts that other people
don't understand or share
••seeing things, hearing things
or feeling things that other
people don't (see our
'Psychosis' resources).
– to the point that others may
not be able to understand or
interrupt
••jumping quickly between
unrelated topics, or saying
things that don't make sense
to other people
••being rude, angry or
aggressive
••doing or saying things that
are inappropriate and out of
character
••losing social inhibitions
••forgetting to look after
yourself – forgetting to eat or
drink, for example
••misusing drugs or alcohol
••taking serious risks with your
safety
••spending money excessively
and inappropriately.

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 What are hypomania and mania?

My speech started getting really fast... I became aggressive

and thought that I could solve the world's problems by myself. I
didn’t sleep, hardly ate or drank and had so much energy that I
would pace around the room.

After an episode
After a hypomanic or manic episode, you might:
••feel very unhappy or ashamed about how you behaved
••have made commitments or taken on responsibilities that now feel
unmanageable
••have only a few clear memories of what happened while you were
manic, or none at all
••feel very tired and need a lot of sleep and rest
••if you experience hypomania or mania as part of another mental
health problem, such as bipolar disorder or schizoaffective disorder,
you may find that the episode is followed by a period of depression.

Then comes the inevitable crash – waking up one morning

after finally sleeping for about 12 hours for the first time in a week
and realising I’ve spent all my money, applied to study courses and
for jobs I’m not even qualified for, and fallen out with everyone who
tried to calm me down.

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Understanding hypomania and mania

What causes hypomania and mania?

There is no single or clear-cut reason that someone may become
hypomanic or manic. It is generally felt to be a combination of long-term
and short-term factors, which differ from person to person.

Possible causes of hypomania or mania include:

••high levels of stress
••changes in sleep patterns or lack of sleep
••use of stimulants such as drugs or alcohol
••seasonal changes – some people are more likely to experience
hypomania and mania in spring
••a significant change in your life – moving house or going through a
divorce, for example
••childbirth (see postpartum psychosis)
••substance abuse
••loss or bereavement
••violence, trauma or abuse
••difficult life conditions – unemployment, poverty, social deprivation or
homelessness
••as a side-effect of medication
••as a side effect of a physical illness or neurological condition
••family history – if you have a family member who experiences bipolar
moods, you are more likely to experience mania or hypomania
••brain chemistry – there is some evidence to suggest that the function
of the nerves in the brain could play a role, although this has not been
definitively proven.

A typical hypomanic episode for me will begin by a night of

hardly any sleep, maybe two to three hours, then the next night I
probably won’t sleep at all.

8
 What causes hypomania and mania?

If you experience hypomania or mania as part of a wider diagnosis, such

as bipolar disorder, schizoaffective disorder or as part of a postnatal illness
such as postpartum psychosis, you can find out more about the causes of
these conditions in our information resource for each diagnosis.

As a side effect of medication

Some medications can cause hypomania or mania as a side-effect, either
while you are taking them or as a withdrawal symptom when you stop.

This includes medications for physical conditions and psychiatric

medications – including some antidepressants (particularly specific
serotonin reuptake inhibitors (SSRIs)).

If you start to experience hypomania or mania and have recently started

or stopped taking medication, check with your doctor whether this could
be the cause.

I had 10 years living with dysmorphia and was eventually

treated with antidepressants and became flirty, flighty, promiscuous,
argumentative and aggressive. When I stopped the treatment, I no
longer experienced these traits.

As a side effect of a physical illness or neurological

condition
Some physical illnesses and disorders can cause hypomania and mania,
including thyroid disorders, HIV/AIDs, lupus, encephilitus and vascular
disease. Neurological conditions, including dementia, Huntington's
disease, brain injury, multiple sclerosis (MS), brain tumours and stroke,
can also cause symptoms of hypomania and mania.

To make sure you get the correct treatment, your doctor should always
check whether there might be a physical cause for your hypomania/mania
before you are diagnosed.

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Understanding hypomania and mania

What treatments can help?

There are a range of treatments available for hypomania and mania. You
might find that you need to try a number of options, along with self-help
techniques, to manage your symptoms effectively.

Before you start any treatment, your GP or psychiatrist should discuss all
your options with you, and your views and preferences should be taken
into account.

Seeking help
Many people do not seek help for hypomania or mania – some people find
it exciting or enjoyable and do not see it as a problem, and some may not
realise that their behaviour is unusual or causing problems. This can mean
that sometimes people receive the wrong diagnosis and treatment, or
don't get treatment when they need it.

If you are seeking help from a doctor, it's a good idea to take note of all
your moods (both high and low) to make sure you get the right diagnosis
and treatment. If you find it hard to recognise when you need help when
you're manic or hypomanic, it can help to agree with professionals, family
and friends in advance what to do if you're becoming unwell.

Physical checks
To make sure you are given the correct treatment, your doctor should
carry out physical checks to make sure your mania or hypomania isn't a
side effect of a physical illness or medication, including antidepressants
such as SSRIs.

Talking treatments
Talking treatments will help you understand yourself better and develop
strategies to deal with hypomania or mania in the future. A talking
treatment is likely to be most effective when your mood is stable. (See
Mind's 'Talking treatments' pages for more information).

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 What treatments can help?

There are no talking treatments that are specifically recommended for

hypomania and mania. Depending on the severity of your symptoms, and
whether you experience hypomania or mania on its own or as part of a
wider diagnosis, you may be offered:
••Cognitive behavioural therapy (CBT) – a short-term, practical therapy
that aims to help you identify patterns that can lead to hypomania and
develop ways to change these.
••Mindfulness-based cognitive therapy (MBCT) – a therapy focused on
living and paying attention to the present moment.
••Psychoeducation – a brief intervention to help you learn coping
strategies, either on your own or in a group.
••Interpersonal therapy – this looks at any problems you have in
communicating and interacting with other people, or relationship
problems.
••Family-focused therapy – this involves working as a family to look at
behavioural traits, identify risks and build communication and problem-
solving skills.

Medication
If you are experiencing mania or hypomania, you will normally be offered
one of these antipsychotics:
••haloperidol
••olanzapine (Zyprexa)
••quetiapine (Seroquel)
••risperidone (Risperdal).

If you experience mania or hypomania, as part of a mood disorder, you

may also be offered mood stabilisers. These include:
••lithium (Camcolit, Liskonum, Priadel)
••valproate semisodium (Depakote)
••carbamazepine (Tegretol)
••lamotrigine (Lamictal).

For more information about these drugs, including side effects and what

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Understanding hypomania and mania

you should know before you take them, see Mind's information on
'Antipsychotics' and 'Lithium and other mood stabilisers'.

Electroconvulsive therapy (ECT)

Very rarely, a treatment called electroconvulsive therapy (ECT) may be
offered. According to NICE (National Institute for Health and Care
Excellence) guidelines, this could be if:
••you're experiencing a long period of mania, and
••other treatments have not worked, or the situation is life-threatening.

If you feel like you're in this situation, your doctor should discuss this
option with you in a clear and accessible way before you make any
decisions. See Mind's 'ECT' resource for more information.

Community-based support
If you experience hypomania or mania regularly, and it has a significant
impact on your ability to carry out daily activities, you may be referred for
community-based support.

This could include:

••health services, such as support from a Community Mental Health
Team (CMHT) or Community Mental Health Nurse (CMHN); Mind's
'Community care and aftercare' pages have further details
••social support, such as support from a social worker or help with
practical day-to-day tasks.

I now have a care co-ordinator and have been stable for a few
months.

12
 How can I help myself?

Crisis services
If you start to feel very unwell, or if an episode of mania is lasting for a
long time and your regular treatment isn't working, you may need to
access crisis services to help you get through it. This may include:
••emergency support, such as going to A&E
••getting support from a crisis resolution and home treatment (CRHT)
team
••hospital admission.

See Mind's pages on 'Crisis services' for more detailed information about
your options in a crisis.

How can I help myself?

There are lots of strategies that can help you to manage your moods, and
reduce the unwanted effects of mania or hypomania. Using these
strategies does not mean that you need to handle everything on your own
– they are often used in combination with other treatments and support
from friends, family and professionals.

Learn more about your condition

Learning more about your condition can help you be more involved in your
care and feel more in control. This could include finding out more about:
••your condition and diagnosis
••possible treatment options
••benefits, services and support available to you and how to access
them
••other people's experiences and what helps them – see Mind's blogs on
our website and Mind's 'Mental health selfies' on YouTube.

If you're looking for information online, make sure you use reputable
websites and know how to stay safe.

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Understanding hypomania and mania

Monitor your moods

Monitoring your moods will help you understand more about yourself and
your mood patterns, and to recognise changes which can be difficult to
spot otherwise. Many people use mood diaries to do this (see 'Useful
contacts' on p.22 for templates and apps). For example:

Day Stress Mood Energy Sleep Comments

(1-10) (1-10) (1-10) (hours)

Mon 4 5 5 7 Relaxed day at

work, nice
lunch with
colleague

Tues 7 7 7 6 Busy day,

stayed late at
work, went to
pub

Weds 6 8 8 5 Really excited

about things
and think I
achieved a lot
today. But my
sister said I
don’t seem to
be concen-
trating

14
 How can I help myself?

Learn to recognise triggers and warning signs

If you can spot the triggers and warning signs of an episode, it can help
you recognise when you are becoming unwell. Triggers and warning signs
can be very personal, so it may take a little while to work out what yours
are. It might help to write this down so you can refer to it if you think you
might be becoming unwell. For example:

Triggers Warning signs

••not sleeping properly or ••staying up until early hours of

missing a night's sleep
••stress at work
••being really busy with
activities and hobbies
••being away a lot at
weekends or not having
enough downtime to relax
••drinking too much caffeine or
alcohol
••skipping meals
the morning, and finding it
hard to stop activities and go
to bed
••being more chatty than usual
and wanting to be with other
people all the time
••buying lots of new clothes and
wanting to wear quite loud
outfits I wouldn't normally
••spending a lot of time on
social media
••feeling impatient with people,
like they can't keep up with
me.

I believed (all the time) that I was always right and everyone
else was always wrong. I was bubbly and my confidence was really
high. At work I would complete tasks simultaneously and felt that
the work was way beneath me. I also started spending a lot and
would spend almost all my wage.

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Understanding hypomania and mania

Make a self-management plan

When you are well, make a plan for what you can do if you start getting
hypomanic or manic, to manage your symptoms and prevent things
getting worse.

For example:
••make yourself go to bed, even if you don't feel tired
••avoid alcohol, caffeine and other stimulants
••avoid stimulating activities
••avoid noisy, bright or busy environments and go somewhere quiet and
calm
••do activities you find calming or soothing
••do relaxation or deep breathing exercises
••avoid making big purchases – you might want to ask someone you
trust to help you manage your finances while you are hypomanic or
manic
••postpone making major life decisions
••avoid situations where you may take part in risky behaviour, such as
driving irresponsibly or taking drugs.

You might need to try a few things to find out what works for you. Bipolar
UK has information and templates to help you create a self-management
plan (see 'Useful contacts' on p.22).

Have a daily routine

Having a regular routine and looking after yourself can help you stay well
and prevent hypomanic or manic episodes. It will also make it easier to
spot changes in your mood or behaviour, and to notice if you are
becoming hypomanic or manic.

••Get good sleep. Try to go to bed and get up at similar times each day.
Make sure you have a calm space to sleep, and try to minimise
stimulating activities before bed (see the Mind resource 'Sleep
problems – tips').

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 How can I help myself?

••Do some physical activity. Exercise can help you feel better and help
you sleep at night. But be careful not to do too much, or too close to
your bedtime, as this can become a trigger (see Mind's resource
'Physical activity, sport and exercise').
••Try to eat well and keep to regular mealtimes (see Mind's 'Food and
mood' resource).
••Keep stress to a minimum. Try to reduce and manage stress as much
as possible (see Mind's resource 'Stress'). Balance stimulating or
stressful activities with relaxing ones, and avoid taking on too many
responsibilities.
••Learn to relax. Prioritise leisure time and build in calming activities so
you have a chance to unwind. You may also find relaxation exercises
helpful.

Involve friends and family

It can help to have conversations with trusted friends or family about your
condition, how it affects you and how they can help.

For example:
••Have honest conversations while you're well about how things feel for
you, and what you do and don't find helpful. For example: 'I find it
frustrating that you think I'm hypomanic every time I'm happy or have
a good day,' or: 'It's really helpful when you notice I haven't been
sleeping much and remind me to get a good night's sleep.'
••Consider involving trusted friends or family members in your self-care
planning. For example, if you're not sure what your triggers or warning
signs are, you could ask if they have seen any patterns or behaviours
around the times that you become unwell. If you find it difficult to
spot your warning signs yourself, you could share these with someone
and ask them to let you know if they see them developing. They may
notice things you don't, or be able to suggest strategies that you
haven't thought of.
••Share your self-care strategies and self-management plan so they
understand how to recognise when you need help and what they can

17
Understanding hypomania and mania

do. This will also help them understand the difference between times
when you feel like you can cope on your own, and times when they
need to help or get you more support.

Use peer support

Sharing experiences and coping strategies with other people who also
experience mental health problems can be a huge source of support (see
Mind's resource 'Peer support'). This could be in a support group, where
you go and meet people in person, or online.

For information about support groups in your area, contact Mind Infoline
on 0300 123 3393. For online support, check out Mind's online community
Elefriends or Bipolar UK's e-community, and make sure you know how to
stay safe online.

Create a crisis plan

It's a good idea to create a crisis plan that explains what you would like to
happen in an emergency, if you become very unwell or are unable to
make decisions for yourself.

This could include:

••who to contact
••what treatments you would like to have or avoid
••at what point you would like people to consider hospital treatment as
an option.

There are many different types of crisis plan. See Mind's 'Planning for a
crisis' online resource for more details.

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 How can friends and family help?

How can friends and family help?

This section is for friends and family who want to support someone they
know with hypomania or mania.

Start a conversation
Have an honest conversation about your friend or family member's
hypomania or mania and how it affects them. Ask them questions about
their experiences and listen to what they have to say. By talking openly,
you can improve your understanding of what things are like for the other
person. This will also build trust so that your friend or family member
feels more comfortable talking about their experiences in future and to
ask for help if they need it.

Ask what you can do

If someone has experienced hypomania or mania before, they will often
have an idea of what helps them and what doesn't. Ask how you can
help. If they don't know, you could offer to help by exploring options
together.

Offer to help with self-management

It might be helpful to work with your friend or family member to help
them identify their triggers and warning signs, and to put together a
self-management plan to help them manage their symptoms better. Ask
questions, make suggestions and remember to listen – you may have
different ideas about what is and isn't a problem. Once you have a final
plan, write it down so you can both look at it if your friend or family
member becomes unwell.

Try not to make assumptions

Try not to question every time your friend or family member is in a good
mood. It's completely normal for everyone to have ups and downs, and it
can be very frustrating if someone starts to worry every time you have a
good day. Instead, look for consistent signs and patterns that they are

19
Understanding hypomania and mania

becoming unwell. It can help to agree what this would look like with the
person beforehand, so you both agree when you think their symptoms are
becoming a problem.

Let them know you're worried

If you're worried that your friend or family member is becoming unwell,
try to address this with them gently. Don't criticise or accuse, and stay
calm and non-confrontational. Explain that you've noticed changes in their
behaviour and why it concerns you. If this has happened before, gently
explain the pattern you see and why it makes you worried. If your friend
or family member says they're fine, suggest that you see how things go
and review the situation in a few days.

Discuss challenging behaviour

If someone is very unwell, they may behave in a difficult or challenging
way and may not see their behaviour as a problem. If this happens, it's
OK for you to set boundaries – for example, that you will end the
conversation if someone is rude or aggressive with you, or that you won't
participate in any grand ideas or schemes if you feel they will have
negative consequences. Explain this calmly to your friend or family
member, and try not to get into an argument.

Be supportive afterwards
If someone has been unwell, they may feel embarrassed or ashamed of
their behaviour. Reassure them that you still care and that you understand
this behaviour is part of their condition and isn't their fault. If your friend
or family member is worried that their behaviour may have long-term
effects, you could offer to help them resolve this – such as helping with a
financial plan or working out how to improve relationships that have been
affected.

Be an advocate
Getting the right care and support can be difficult and frustrating,
particularly if you are unwell, so your friend or family member may want

20
 How can friends and family help?

you to help with this. For example, you could offer to research treatments
or self-help techniques, find information about support groups in your
area, or look into finding a mental health advocate (see Mind's pages on
'Advocacy' for more information).

Plan for a crisis

It's a good idea to make a crisis plan that explains what to do if someone
becomes very unwell. This would include who to contact, what to do and
when would be an appropriate time to consider hospital treatment. Agree
this in advance, and keep a written copy.

Look after yourself

You may feel very worried about your friend or family member, but it’s
also important to invest some time and energy into looking after yourself.
Making sure that you stay well will enable you to continue to offer them
support. You can find out more about looking after yourself on Mind's
pages 'How to cope as a carer' and 'Improving and maintaining your
wellbeing'. You can also visit the Carers UK website (see 'Useful contacts'
on p.22).

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Understanding hypomania and mania
Useful contacts
Be Mindful
web: bemindful.co.uk
Explains the principles behind
mindfulness, and gives details of
local courses and therapists.
Bipolar UK
tel: 020 7931 6480
web: bipolaruk.org.uk
Information and support for people
with bipolar disorder, hypomania
or mania, and their families and
friends. Online community, support
groups and self-help tools including
a mood scale and mood diary.
British Association for Behavioural
and Cognitive Psychotherapies
(BABCP)
tel: 0161 705 4304
web: babcp.com
Can provide details of accredited
therapists.
British Association for Counselling
and Psychotherapy (BACP)
tel: 01455 883 300
web: itsgoodtotalk.org.uk
For practitioners in your area.
22
Useful contacts
Carers UK
tel: 0808 808 7777
web: carersuk.org
Practical information and support for
people who are carers.
Elefriends
web: elefriends.org.uk
A safe, supportive online community
where you can listen, be heard and
share your experiences with others.
Healthtalk.org
web: healthtalk.org
Information, videos and audio of
people's personal experiences of
hypomania and mania.
Hearing Voices Network
helpline: 0114 271 8210
web: hearing-voices.org
Local support groups and
information for people who hear
voices.
Improving Access to Psychological
Therapies (IAPT)
web: nhs.uk/Service-Search
Use the NHS service search to find
psychological therapies services
near you.
22
 Useful contacts

Mood diaries Samaritans

websites: helpline: 116 123 (freephone)
moodpanda.com web: samaritans.org
moodscope.com email: jo@samaritans.org
medhelp.org/land/moodtracker Freepost RSRB-KKBY-CYJK
mappiness.org.uk Chris PO Box 90 90
Some examples of mood diaries – Stirling FK8 2SA
many more are available. 24-hour emotional support for
anyone struggling to cope.
National Institute for Health and
Care Excellence (NICE)
web: nice.org.uk
Produces guidelines about best
practice care for people with
hypomania and mania.

NHS Choices
web: nhs.uk
Health information, including info
about mental health and physical
conditions that cause mania.
.
Post Natal Depression & Puerperal
Psychosis
web: puerperalpsychosis.org.uk
Information, support and an online
forum for people experiencing
puerperal psychosis.

23
Further information
Mind offers a range of mental
health information on:
• diagnoses
• treatments
• practical help for wellbeing
• mental health legislation
• where to get help
To read or print Mind’s
information booklets for
free, visit mind.org.uk
or contact Mind Infoline
on 0300 123 3393 or at
info@mind.org.uk
To buy copies of Mind’s
information booklets, visit
mind.org.uk/shop or
phone 0844 448 4448 or email
publications@mind.org.uk
This information was written by
Celia Warin
Published by Mind 2016 © 2016
To be revised 2019
No reproduction without permission
References available on request
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England and Wales. We believe no one should
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